Child Safeguarding

Child Safeguarding is the responsibility of all everybody and is highly regarded at the Surgery. We make every effort to recognise issues and address as they occur in the practice. By raising safeguarding children issues within the practice all staff will be aware of how they may access advice, understand their role in protection, and understand the importance of effective Inter-agency communication.

It is very important that all Practice staff understand the need for early identification, assessment and intervention when they have concerns about a child. Case discussion and reflective practice is encouraged. Child protection issues in general practice require a robust system of note-keeping and recording, message handling and communication of any concerns.

Key Factors to be aware of in safeguarding children

The welfare of the child is paramount

Be prepared to consult with colleagues

Be prepared to take advice from local experts

Keep comprehensive, clear, contemporaneous records

Be aware of GMC guidance about sharing confidential information

Risk Factors and Identification – Child Sexual Exploitation

A child in need is defined as a child whose vulnerability is such that they are unlikely to reach or maintain a satisfactory level of health or development without the provision of services (section 17, Children’s Act 1989). This includes disabled children. The Children’s Acts 1984 and 2004 define a child as someone who has not reached their 18th birthday. The fact that a child has reached their 16th birthday and may be living independently, working, or be members of the armed forces does not remove their childhood status under the Acts.

Local authority social services departments working with other local authority departments and health services have a duty to safeguard and promote the welfare of children in their area who are in need. If you are considering making a referral to Social Services as a child in need, it is essential to discuss the referral with the child’s parents or carers and to obtain consent for the sharing of information. Social Services will then follow local procedures to undertake an assessment of the child and their family.

Child Protection Plan

Children judged to be at continuing risk have a child protection plan in place, this list is maintained by children’s social care (CSC).CSC, police and health professionals have 24 hour access to this. A child on the register has a “key worker” to whom reference can be made.

Recognising Child Abuse

(for full details please ref to Working Together to Safeguard Children 2013)

There are 4 main categories of child abuse:

Physical abuse

Sexual abuse

Emotional abuse

Neglect/failure to thrive

These are not however exclusive, and a number of abuse types can often coexist.

Physical abuse may include:

Injuries in children under 1 years of age or non-mobile children should be treated with a high degree of care

Hitting, shaking, throwing, poisoning, burning or scalding, or other forms of physical harm

Where a parent or carer deliberately causes ill-health of a child

Single traumatic events or repeated incidents

FGM

Sexual abuse may include:

Forcing or enticing a child under 18 to take part in sexual activities where the child is unaware of what is happening

May include both physical contact acts and non—contact acts

Emotional abuse may include:

Persistent ill-treatment which has an effect on emotional development

Conveyance of a message of being un-loved, worthlessness or inadequacy

May instill a feeling of danger, being afraid

May involve child exploitation or corruption

Living in families where domestic violence is taking place

Neglect may include:

Failure to meet the child’s physical or psychological needs

Failure to provide adequate food or shelter

Failure to protect from physical harm

Neglect of a child’s emotional needs

Common presentations and situations in which child abuse may be suspected include:

Disclosure by a child or young person

Physical signs and symptoms giving rise to suspicion of any category of abuse

The history is inconsistent or changes

A delay in seeking medical help

Extreme or worrying behaviour of a child, taking account of the developmental age of the child

Accumulation of minor incidents giving rise to a level of concern, including frequent A&E attendances

Some other situations which need careful consideration are:

Disclosure by an adult of abusive activities

Girls under 16 presenting with pregnancy or sexually transmitted disease, especially those with learning difficulties

Blood Pressure Monitoring

Who do I see: Health Care AssistantAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Blood Tests

Who do I see: Health Care AssistantAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment. Clinics from 8am daily. Appointments for blood tests MUST have been requested by your doctor or other health care professional.For warfarin monitoring it is preferred for all samples to be taken at the beginning of the week.If you are in doubt please call to speak to one of our Practice Nurses who will advise you.

Blue Badge Forms

Boils

Who do I see: GPAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Breathlessness

Who do I see: Practice Nurse/GP or A&E for severe symptomsAdvice: Telephone 999 or 111 if symptoms are severe. For less serious breathing issues such as COPD or chest infections, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Cellulitis

Who do I see: Practice NurseAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Cervical Smears

Who do I see: Practice NurseAdvice: Once you are invited, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment, on a day that you are not bleeding or on your period.

Chest Infections

Who do I see: GP if persists for more than 1 week, or other chest issues (asthma)Advice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment. Routine appointments within 2 – 4 weeks.

Chest Pain

Who do I see: GP or A&E for severe symptomsAdvice: Telephone 999 or 111 if symptoms are severe. If not severe and has lasted for more than a few days, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Children’s Immunisations

Who do I see: Practice NurseAdvice: Baby Clinic is run by our Practice Nurses, appointments needed for immunisations; please book an appointment online, or contact reception on 020 8567 1121 to make an appointment. Find out more at NHS Choices.

Chronic Heart Disease

Who do I see: Practice Nurse or GPAdvice: Annual clinic appointments will be sent to all CHD patients, please ask for an earlier appointment if worried.

Coils or Implants

Who do I see: GPAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment with the correct GP.

Colds

Constipation or Piles

Who do I see: Community Pharmacy/GP if persists more than 1 weekAdvice:Search for your nearest community pharmacist. For a GP, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment. Routine appointments within 2 – 4 weeks.

Contraception and Family Planning

Who do I see: Family Planning Clinic/GP/Practice NurseAdvice:Find out more information about Ealing Family Planning Clinics. Contraception and family planning appointments are available at various times every day. For a GP or a Practice Nurse, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment. Routine appointments within 2 – 4 weeks.

Cough

Who do I see: Community Pharmacy/GP if persists for more than 3 weeksAdvice:Search for your nearest community pharmacist. For a GP, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment. Routine appointments within 2 – 4 weeks.

Dementia Screening

Who do I see: Healthcare Assistant/Practice NurseAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Dental Problems

Who do I see: Dentist/GP for dental abscess if no emergency dentist availableAdvice: Please book an appointment with your dentist or find a dentist near you: NHS Find Dentist Services. For a GP, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Depot Injection (other)

Who do I see: Practice NurseAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Depot Injection (contraception)

Who do I see: Family Planning Clinic/GP/Practice NurseAdvice:Find out more information about Ealing Family Planning Clinics. Contraception and family planning appointments are available at various times every day. For a GP or a Practice Nurse, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment. Routine appointments within 2 – 4 weeks.

Depression

Who do I see: IAPT Service/GPAdvice: Visit ealingiapt.co.uk for IAPT services, or please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Diabetes Monitoring

Who do I see:Healthcare Assistant/Practice Nurse (full annual)/Clinical Pharmacist (medication)Advice:Routine annual clinic appointments reminders will be sent to all our patients with diabetes. Reception staff will direct you to the most appropriate health care professional. For the surgery, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Diarrhoea

Who do I see: Community Pharmacist/GP if persists longer than 7 days or in a career dealing with food or caring for othersAdvice:Search for your nearest community pharmacist. For a GP, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Diet/Lifestyle Changes

Who do I see: ONE YOU Ealing, Heath Care AssistantAdvice: Please visit oneyouealing.org, Tel: 0300 4560556, or for a Health Care Assistant, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Dizziness

Who do I see: GPAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Dressings

Who do I see: Health Care Assistant/Practice NurseAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Drug Addiction

Ear Care/Ear Wax

Who do I see: Community Pharmacy/Heath Care AssistantAdvice:Search for your nearest community pharmacist. If you think you may need ear irrigation (‘syringing’ ) please speak to one of our Health Care Assistants who will advise you by booking an appointment online, or contacting reception on 020 8567 1121 to make an appointment. Also please check the following information on NHS Choices.

Earache

Who do I see: GPAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

ECG

Who do I see: Health Care Assistant/Practice NurseAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Eye Injuries

Fit Note (Sick note)

Who do I see: Self certify first 7 days, then routine GP appointmentAdvice: For a GP, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment. If you have been discharged from hospital, your hospital team will issue any fit notes for the entire period of your recovery. Please contact the ward staff (even after discharge). Schools should not request a GP letter to confirm absence, this can be written by a parent or guardian.

Flu Vaccine

Who do I see: Practice NurseAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Forms, certificates and medicals

Who do I see: Medical SecretaryAdvice: A medial examination will be booked if necessary. Completion of forms, certificates and medicals are not covered under the NHS. Payment for reports must accompany the request or appointment booking (i.e. in advance). Charges are aligned with the BMA’s guidelines. Please read the form carefully and fill in and sign any parts that you need to complete before you bring the form to the surgery. Allow up to 28 days for the process to be completed, you will be contacted by phone when your form is ready for collection. Please note we do not sign passport forms.

Headaches

Who do I see: GPAdvice: For a GP, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Holiday Cancellation Certificate

Who do I see: GP Surgery ReceptionistAdvice:Please attend in person or post the documentation and payment. Holiday Cancellation forms are not covered by the NHS, there will be a charge for this service. Payment for reports must accompany the request or booking (i.e. in advance). Charges are aligned with the BMA’s guidelines. Please read the form carefully and fill in and sign any parts that you need to complete before you bring the form to the surgery. We ask that you allow up to 28 days for the process to be completed, you will be contacted by phone when your form is ready for collection.

Hyperventilation

Who do I see: IAPT Service/GPAdvice: Please visit ealingiapt.co.uk or for a GP, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Insurance Reports

Who do I see: GP Surgery ReceptionistAdvice: Completion of forms, certificates and medicals are not covered under the NHS. Please read the form carefully and fill in and sign any parts that you need to complete before you bring the form to the surgery. We ask that you allow up to 21 days for the process to be completed, you will be contacted by phone when your form is ready for collection.

Medical Reports

Who do I see: GP Surgery ReceptionistAdvice: Completion of forms, certificates and medicals are not covered under the NHS. Please read the form carefully and fill in and sign any parts that you need to complete before you bring the form to the surgery. We ask that you allow up to 21 days for the process to be completed, you will be contacted by phone when your form is ready for collection.

Medication Reviews

Who do I see: Clinical PharmacistAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Moles

Who do I see: GPAdvice: For a GP, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Mouth Problems

Who do I see: Community Pharmacy/Dentist/GP for Dental abscess if not emergency dentist availableAdvice: Please book an appointment with your dentist or find a dentist near you: NHS Find Dentist Services, or you may find your nearest community pharmacy. For a GP, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Removal of Stitches

Who do I see: Practice Nurse/Health Care AssistantAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Ring Pessary

Who do I see: GPAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Shingles Vaccine

Who do I see: Practice NurseAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Sick Note (Fit Note)

Who do I see: Self certify first 7 days, then routine GP appointmentAdvice: For a GP, please book an appointment online, or contact reception on 020 8567 1121 to make an appointment. Routine appointments are usually within 2-4 weeks. If you have been discharged from hospital, your hospital team will issue any fit notes for the entire period of your recovery. Please contact the ward staff (even after discharge). Schools should not request a GP letter to confirm absence, this can be written by a parent or guardian.

Smoking Cessation

Who do I see: OneYou Ealing/SmokeFree Clinics EalingAdvice: You can visit oneyouealing.org, Tel: 0300 4560556, or phone SmokeFree Clinics Ealing on 0800 8766683 or 02007 5798622. Find out more from the NHS advice page.

Travel Vaccinations

Who do I see: Practice NurseAdvice: Please book at least 1 month before travelling and either book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Urine Infections

Who do I see: GPAdvice: Please bring a urine sample into the consultation; sterile pots available at reception. Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Vitamin B12 Injection

Who do I see: Practice NurseAdvice: Please book an appointment online, or contact reception on 020 8567 1121 to make an appointment.

Vomiting

Who do I see: Community Pharmacy/GPAdvice:Please search for your nearest community pharmacist. For babies and toddlers, or if it persists longer than 1 week in children and adults, please see the GP by booking an appointment online, or contacting reception on 020 8567 1121 to make an appointment.

Warfarin Monitoring

Who do I see: Health Care Assistant/Practice NurseAdvice: Please book an appointment online,or contact reception on 020 8567 1121 to make an appointment.